Healthcare Provider Details

I. General information

NPI: 1164506911
Provider Name (Legal Business Name): HERBERT N BRETL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 S 3RD AVE
EDGAR WI
54426-9281
US

IV. Provider business mailing address

3109 SHOREY AVE
SCHOFIELD WI
54476-5648
US

V. Phone/Fax

Practice location:
  • Phone: 715-352-2700
  • Fax: 715-842-4369
Mailing address:
  • Phone: 715-355-7077
  • Fax: 715-842-4369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5378-015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: